AB1617 DIFFERENCES IN ACCESS TO RHEUMATOLOGICAL CARE OF PATIENTS WITH CHRONIC POLYARTHRITIS AND CONNECTIVE TISSUE DISEASES: A PILOT STUDY USING INTERACTIVE PROCESS MINING ANALYSIS
Authors: A. Madrid García, J. L. Bayo-Monton, J. C. Estevez-Muñoz, G. Ibañez-Sanchez, Y. Lopiz-Morales, C. Fernández-Llatas, L. Rodriguez Rodriguez
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Process mining is a research discipline used to derive process-related knowledge from data on event occurrences at different times. In the healthcare domain, these techniques can be applied to outpatient processes to extract information regarding how they take place and identify inefficiencies or points form improvement. <h3>Objectives</h3> Our aim was to analyze how patients that receive a diagnosis of chronic polyarthritis (CP; including conditions such as rheumatoid arthritis and undifferentiated arthritis) or connective tissue diseases (CTD; such a Systemic Lupus Erythematosus, scleroderma or vasculitis) access a tertiary care level rheumatology outpatient clinic, using novel process mining techniques. <h3>Methods</h3> Retrospective study, including patients first seen at the Hospital Clínico San Carlos Rheumatology Outpatient clinic between 2016 and 2019, belonging to the Hospital Clínico San Carlos Musculoskeletal Cohort. We included those patients receiving ICD10 diagnostic codes, by their attending rheumatologists, compatible with Adult-onset Still's disease, undifferentiated polyarthritis, polymyalgia rheumatica and rheumatoid arthritis (which were later grouped under the category of "chronic polyarthritis"), and myositis, antiphospholipid syndrome, sarcoidosis, Behçet disease, polymyositis, scleroderma, mixed connective tissue disease, Sjögren syndrome, systemic lupus erythematosus, vasculitis and Raynaud's syndrome (which were later grouped under the category of "connective tissue diseases"). Information regarding outpatient activity at the Rheumatology clinic (dates of appointments, if they were a first visit in the clinic or a revision, and which department requested the appointment) was obtained from the Hospital Information System (HIS). Process Mining techniques were used to visualize the pathways followed by the patients included in both categories, and to highlight differences. <h3>Results</h3> 174 patients with CTDs and 341 patients diagnosed with CPs were analyzed. Regarding CPs, most patients were initially referred from Primary Care. Furthermore, most of those patients were not referred from other departments. However, we also can see that some patients undergo several referrals from different departments. Regarding CTDs, although Primary Care seems to be the most common level of referral, other origins are more likely. When the pathways of both disease classifications are compared (Figure 1), we can observe that, compared with CPs, CTDs, have a lower chance of being referred from the Orthopedic Department ("TRA-REU" node in blue) and a higher chance of being referred from "other departments" in secondary care ("REU" node in red). Furthermore, it is less likely that a patient with CTD undergo referrals from different departments and care levels during follow-up (seeing by the lines in blue color connecting the nodes "TRA-REU", "URG-REU", "PRI-REU", and "REU Rev"). <h3>Conclusion</h3> In this pilot analysis, we have observed that the pathways followed and the referral departments of the patients diagnosed with CPs and CTDs are different. Process mining can be a very useful tool to characterize and identify the pathways that patients undergo within the healthcare system, across levels and specialties. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.